Affordable Care Act Update: Final Regulations for 90-Day Waiting Period Released

February 21, 2014 at 11:19 am | Posted in Affordable Care Act, Compliance, Creditable Coverage, Department of Labor, Employment Law, Federal Taxes, Health and Human Services, Health Care, PPACA, Regulations | Leave a comment
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On February 20th, The U.S. Departments of Labor, Treasury, and Health and Human Services published final regulations (85 pages) implementing a 90-day limit on waiting periods for health coverage. The final regulations require that no group health plan or group health insurance issuer impose a waiting period that exceeds 90 days after an employee is otherwise eligible for coverage. The rules do not require coverage be offered to any particular individual or class of individuals.

To ensure that eligibility conditions based solely on the passage of time are not used to evade the waiting period limit, the rules state that such conditions cannot exceed 90 days. Other conditions for eligibility are generally permissible, such as meeting certain sales goals, earning a certain level of commission, or successfully completing an orientation period.

Additionally, requiring employees to complete a certain number of hours before becoming eligible for coverage is generally allowed as long as the requirement is capped at 1,200 hours. The rules also address situations in which it cannot be determined that a new employee will be working full-time.

The departments are issuing a companion proposed rule that would limit the maximum duration of an otherwise permissible orientation period to one month. This proposal will be open for public comment.

A link to the final rule is here:

U.S. Supreme Court to Address Constitutionality of Affordable Care Act’s Contraception Mandate On Private Employers

November 26, 2013 at 1:04 pm | Posted in Affordable Care Act, Compliance, Creditable Coverage, Essential Health Benefits, Federal Laws, Health Care, Medical, PPACA, Regulations, Wellness | Leave a comment
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The Supreme Court announced today that it will accept for hearing and decision the constitutional challenge to the Affordable Care Act’s (ACA) contraception mandate as it applies to private employers who have a religious objection to the mandate. The contraception mandate is part of one of the ten required health essential benefits (women’s preventive health services) required of health plans under ACA.

There is currently a disagreement among the federal Circuit Courts of Appeals as to its constitutionality. It is reported that the hearing will be this spring.

Massachusetts Insurance Commissioner: State Will Not Adopt Obama Initiative to Allow Individuals and Small Groups to Keep Their Cancelled 2013 Policies

November 20, 2013 at 9:18 am | Posted in Affordable Care Act, Creditable Coverage, Health Care | Leave a comment
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Massachusetts Commissioner of Insurance, Joseph Murphy, has advised the Obama Administration that Massachusetts will not accept the President’s November 14th transitional policy proposal that would allow a one year grace period for individual and small group health insurance coverage to keep their 2013 cancelled policies and to delay compliance with the essential benefits coverage (EBC) provision of the Affordable Care Act. The President’s policy proposal was in response to the uproar triggered by his representation that if “You like your plan, you can keep it” in conjunction with the cancellation of millions of policies that were not in compliance with the coming 2014 EBC requirement. The basis for the rejection of the President’s proposal was the state’s successful experience under Massachusetts Health Care Reform, the similarity of Massachusetts creditable coverage requirement, and the conclusion that to allow carriers to make the type of change proposed by the President would “cause confusion and significant market disruption.”

Click Here: to read Commissioner Murphy’s November 18th letter to the U.S. Department of Health and Human Services

Treasury Department To Congress: Cannot Foresee Additional Delays in Roll Out of the Affordable Care Act

July 19, 2013 at 9:46 am | Posted in Affordable Care Act, Creditable Coverage, Health Care, Health Insurance Exchanges, Health Insurance Marketplace, Medical, PPACA, Regulations | Leave a comment
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According to the July 19th edition of HealthWatch

A top Treasury official on Thursday suggested that his department has no current plans to delay additional provisions of the ObamaCare. J. Mark Iwry, Treasury’s deputy assistant secretary for retirement and health policy, told lawmakers that the employer mandate is the only policy that has been considered for deferral. “We don’t have any specific provision that we’ve identified for which we would give some relief,” Iwry said in witness testimony.

A senior adviser to the Treasury secretary, Iwry appeared before the House Energy and Commerce subcommittee on Oversight and Investigations on Thursday. It was his second time testifying on the employer mandate delay in one week.

Republicans grilled Iwry on the legal justification for the administration’s decision to push the policy’s enactment to 2015. GOP lawmakers also urged him to explain whether Treasury has the ability to also delay the individual mandate to buy health insurance. Iwry replied that his department had not conducted the necessary analysis to answer that question.

The House on Wednesday passed legislation that would delay the rule that most individuals carry health coverage starting Jan. 1. Republicans and some Democrats argued that individuals should not be required to comply next year if businesses will not be required to provide insurance until 2015.

On Thursday, the GOP pressured Iwry to explain why his department has not chosen to delay the individual mandate. Iwry said that Treasury hasn’t heard a reason to defer the policy that is “comparable” to the reasons cited for delaying the employer mandate. Businesses had called for more flexibility in order to comply with elaborate reporting requirements under the rule.

In a moment of rage, Energy and Commerce Vice Chairman Marsha Blackburn (R-Tenn.) said the administration was “trying to cater to big business but not to hardworking taxpayers.”

Rep. Diana DeGette (Colo.), the subcommittee’s top Democrat, cited one major reason not to delay the individual mandate — the move would cause premiums to spike. “If you delay the individual mandate for a year, many, many millions of Americans … won’t be able to get affordable health insurance through these [insurance] exchanges,” DeGette said.

Employer’s Prescription Drug Plan Creditable Disclosure Requirement to CMS – Nothing has Changed

October 18, 2011 at 10:34 am | Posted in CMS, Creditable Coverage, Prescription | Leave a comment
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In September we emailed a client alert announcing the new October 15thdeadline for employer plan sponsors to distribute the required annual Medicare Part D Creditable Coverage Notices to their affected employees, retirees, and their dependents.

We received a few calls from clients inquiring about the date for employer plan sponsors to complete the Online Disclosure requirement to the Centers for Medicare and Medicaid Services (CMS) regarding the creditable or non-creditable status of their prospective group health plan’s prescription drug program.  The date of the Online Disclosure requirement has not changed.  Generally, disclosure of the plan’s prescription drug creditable status remains due within 60 days of the beginning of the Plan year. 

Examples of reporting deadlines:

Plan Year Begins Online Due Date to Report to CMS
January 1 March 1
February 1 April 1
March 1 May 1
April 1 June 1
May 1 July 1
June 1 August 1
July 1 September 1
August 1 October 1
September 1 November 1
October 1 December 1
November 1 January 1
December 1 February 1

The only exceptions to the above Online Disclosure requirement are if: (1) the prescription drug program is terminated, or (2) the prescription drug program loses its creditable coverage status. If either of those events were to occur, the employer plan sponsor must provide Online Disclosure to CMS within 30 days of the event’s occurrence.

As always, we welcome the chance to answer any questions about these two distinct employer plan sponsor requirements and deadlines.

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